Healthcare Provider Details

I. General information

NPI: 1992631592
Provider Name (Legal Business Name): TAMPA GENERAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8172 CHAUCER DR
WEEKI WACHEE FL
34607-2204
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 352-653-1101
  • Fax: 833-449-4097
Mailing address:
  • Phone: 813-844-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER TRAVIS RIAD CHANG
Title or Position: SVP CHIEF TRNSFRMTN OFCR FHSC
Credential:
Phone: 813-844-3829